MEDICARE: BEACH FAMILY MEDICINE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	0101025209	VA

General Provider Information

NPI Number	:	1245449776
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEACH FAMILY MEDICINE, INC.

Provider Business Mailing Address
First Line	:	1783 UPPER CHELSEA REACH
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-1124
Country	:	US
Telephone Number	:	757-499-9671
Fax Number	:

Provider Business Practice Location Address
First Line	:	1856 COLONIAL MEDICAL COURT
Second Line	:	SUITE B
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-3075
Country	:	US
Telephone Number	:	757-499-9671
Fax Number	:

Authorized Official
Title or Position	:	CHAIRMAN
Name	:	DR. GREGORY ALAN HAASE
Credential	:	MD
Telephone Number	:	757-499-9671

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	06/17/2011

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